Knee replacement and physio

[Lookrider]

I'm due to have a Total knee replacement
I " think" there was a cyclist on here who is a physio and also had a replacement
He put a couple of very informative posts regarding physio to do
I cannot find this post or topic
So if by chance this physio does read this could he reply to it again or provide a link to his previous advice
Thanks all

[Paulatic]

This is what you were looking for viewtopic.php?t=151315

I am a chartered Physiotherapist formerly head of the British Olympic teams specialising in athletics and musculoskeletal medicine. I am 63 years old and underwent a TKR ( total knee replacement) 8 weeks ago. I have treated and rehabilitated over 500 patients from all walks of life and varying backgrounds. I am going to give you my advice as both a clinician and a patient and I hope it doesn’t sound too harsh. My experiences are from 2 completely different perspectives. I hope the following will be of help to anyone. My aim is to give a background of what to expect during the first 8 weeks of this process and which I consider the most difficult.
I’ve tried to give some helpful pointers of what to expect and what to do at the early stages to reach a successful outcome.
The standout phrase is that it’s very different being a patient as opposed to being the treating clinician. This surgery has altered my perspective and I’ve personally experienced situations that may not be always obvious as a treating clinician. I will see you for one to 3 hours per week depending upon the stage of your post operative phase. I do not see you at home at night in bed when you can’t sleep or you struggle to go to the toilet or bathroom. I do not see you when you are struggling to get your meals or when you are feeling nauseous etc. I only see you when you are at your relative best during the daytime. It’s the night time that can be is the most challenging for any knee replacement patient.

One of the biggest producers of pain immediately post op is that of the thigh pain. This is due to a tourniquet that is placed around the thigh during surgery to reduce bleeding into the joint. It makes it easier for the surgeon to perform the op. You will find that this limits your knee bend as it causes considerable bruising to the front, inner and posterior part of your thigh. Do not underestimate how painful and limiting this is. That being said it settles at 2-3 weeks as the bruising becomes reabsorbed. This is superficial pain and you just have to push through this.

Night Pain -You will find that the joint is painful at night and not so bad in the day. This is because the body wants to reject the implant and it produces enzymes which raise the level of inflammation more so at night time due to the circulation slowing down and the bodies natural circadian rhythm releasing serotonin dopamine and oxytocin. I found that all was relatively well in the daytime and I could control the pain with ice. However and frustratingly I could guarantee as soon as it went dark within an hour of getting into bed the pain kicked in. For 2 weeks it was horrible despite painkillers /ice etc. I can assure you that this phase will go and is only temporary. It should be emphasised more in hospital.

IMPORTANT THINGS TO DO ?
I assume you will all be given specific post op exercises on a written sheet or app -so for the purpose of this brief I will assume anything else I add will be in addition to those basic exercises.
1, make an itinerary for both your stretching and exercises and tick it off each session.
2. make sure you have someone you can talk or chat to. You will need some help in the first 2 weeks to help with shopping, house old cleaning and cooking etc .
3. Make a list of small things like to do for example reading books, jigsaws puzzles and that articles that have been building up in the past to read. Listen to podcasts, try learning new hobbies. The internet is full of fascinating things to try. Up skill your DIY skills via YouTube. Put your photographs in order, anything to keep yourself occupied.
4.Do not watch day time TV as you need to try to maintain a normal day/ nighttime routine.
5.Make sure you tick off each little task or job as an achievement it will help to normalise your mental well-being.
6. Separate night from day. Whatever you do not sleep in the daytime no matter how tired you become. Don’t worry you will sleep when you become exhausted at nighttime eventually.

THE MOST IMPORTANT RULE -
7. Do not have this surgery unless you have the mindset to work very hard.The surgery is the relative easy bit. It’s the postop rehab that’s hard. If you did nothing after your surgery, you will have a permanently stiff and functionless knee and a lot of pain. The surgery is doomed to failure.

8. Do not confuse this surgery to that of a hip replacement. The hip is a stroll in the park in comparison.

9. The most important aspect is the bending and straightening of the joint.
In my experience when people have told me they haven’t had a successful outcome it’s usually because they didn’t work hard enough to bend and straighten that joint in the first 6 weeks.
10. ONE BIG PIECE OF ADVICE - take your pain relief. Some of you will hate taking painkillers. If you don’t You won’t be able to do the exercises or the required rehab. Taking the medication It’s usually for 3-4 weeks only. I stopped taking mine after 3 weeks as I had 0 degrees extension and 130 degrees of flexion ( bending).
11. The worst phase of this knee rehab is the first 2-3 weeks.
12. Lose excess body weight as this will reduce your chances of blood clots.
13. Ice therapy will be your god - use for 20 minutes 4-5 times per day and make sure you elevate that knee. Do not sit with your feet on the floor. This will cause you knee and ankles to swell. Keep that leg elevated and make sure you follow those foot and ankle exercises you’ve been given from hospital.
14. Note - when using ice tub some virgin olive oil or cooking oil or any oil to create a barrier between your skin and the ice. The ice will eventually freeze the m]water molecules in the skin surface and cause ice burns which will then make it impossible to ice that area. Ice burns are painful and we have enough pain as it is. That’s why the oily fish in the sea are in the cold iced waters as they have evolved to survive this harsh environment.
15. I used a cryocuff which is a tub of iced water and it fills a water proof covering under pressure placed around the knee joint. One of the best £75 (Amazon ) you will ever spend! You may be able to hire one from the hospital or get one second hand on the internet or from a friend. You v[can use regular ice packs or ice in a wet towel or in a plastic bag .

16. You will struggle to sleep and usually you will fall asleep usually due to exhaustion. Do not sleep with a pillow under your knee at any cost. This will cause your knee to stiffen. Roll a second duvet up and put it under your calf and ankle. This allows you to lie on your back with your leg elevated whilst asleep (and it’s comfortable). You will struggle to lie on your side for the first 2-3 weeks due to the capsule release and knee swelling.if you’ve had a varus knee position prior to your surgery (leg became bow legged) the surgeon cuts the inner medial ligament and it needs 3-4 weeks to heal in a lengthened position.
17. Your head will feel a little foggy for a few weeks due to the analgesia. It’s ok you won’t become addicted or dependent on these medications they are low range Analgesia. In hospital you may take oxycodone for 2 days and they are schedule 2 drugs which are controlled and include the Diamorphine, fentanyl groups. These are addictive and that’s why you will only get 4 tablets in hospital over 2 days. They are powerful and will eliminate any pain. You will not be come addicted to them due to how limited supply the consultant will prescribe for you. You will then be prescribed Co- codamol, paracetamol and an anti inflammatory medication. These are much less effective but will take the edge of the pain for the next few weeks. Don’t worry you won’t become addicted to them, but they are essential and are an integral part of the rehab process to a successful outcome.
18. Do not be fearful of the surgery. If you follow the rules you WILL have a positive and functional outcome and you will be able to return to your cycling as previous.

19.The new replacement does have a shelf life of 15-20 years if you look after them . I always tell my patients NEVER TO RUN ON THEM, they are not designed to take that loading or biomechanical stress. You will wear the joint quickly and they will last 5-8 years if you are lucky ! I was a former athlete and and miss my running but I know I can never run on my replacement joints.
20.The magic of cycling swimming are that they are low impact activities and loads are greatly reduced in the replacement.
21. Running can cause loosening of the joint which will result in further surgery and an additional replacement and months of pain in between. A second knee replacement or a revision procedure is far harder to do second time around and the outcome is not always as good.
22. You can return to a full cycling program as previous but take your time. That replacement continues to improve for up to 2 years.
23.Remember -You are retired or off work and you are at home to rehab not to sit and watch Netflicks !!.
24.You will get muscle atrophy or wastage after the operation. The better condition you keep your muscles prior to surgery the quicker you will continue to improve.You can lose almost 2 inches of quads/ hamstrings within 36-48 hours. That’s why physios see you within a few hours of you arriving back from theatre to begin quads exercises and to improve your circulation.!

25. I tell patients that once they’ve made the decision to have the surgery, go for it in terms of any exercise use you can do within your pain levels whether that be that cycling swimming or machine weights. I accept some patients just cannot do anything apart from simple quads exercises. Anything is better than nothing !!.
26.lose excess body weight this is vital. Do you realise that for every pound of extra fat around your middle you have to grow a further 2 miles of blood capillaries to to service that extra fat. That’s one of the reasons why we get a little touchy about patients carrying excess weight as it increases the risk of clot formation and further cardiovascular pathologies. Importantly it damages the new replacement and wears it out more quickly.
27. I exercised every 2 hours and emphasised the bending and straightening of the knee for the first 6 weeks. Once you gain your range the muscle will eventually strengthen with time and gradual loading. With joint range you have a 6-8 week window so this is your priority.

28.Remember not to push the walking and muscle strengthening in weight bearing excessively. Gradually increase your walking distances every 3 days from 10 mins day for the first week to 30 mins daily week 3-4. Those metal prosthesis have to heal and bone has to grow around them. The sealed capsule around the joint has to heal this is the synovial capsule and also controls the level of fluid produced within the joint.
29. You have to remember there is a natural healing time which has to take place whilst you are rehabbing. If a tissue takes 6 weeks to heal there is nothing you can do that will make it heal in 4 weeks. There’s much you can do though that will hinder or delay healing if you push too quickly.

30. Do not push the knee excessively in terms of weight bearing strengthening for the first 6-8 weeks. You will suffer and the knee will swell and you will not sleep. I always use the term ‘being kind to the joint’ ideally we want a happy joint with the knee gradually reducing in swelling over the first 6 weeks.

31. One of the best methods to get that knee bend (and I use it with all my knee patients) is ;
To lie on the floor on your back cushion under your head. Make sure your bottom is approx 14 inches from a wall or the arm of a sofa. Now put your affected foot (and wear socks as it’s easier to slide on the wall). Slide your foot down the wall until you feel your knee bend and gradually tighten. Now hold it for a 2 minute period minimum. Next put your good heel over the ankle and gently tap the the ankle downwards so that the affected knee bends further. Hold for 2 mins and repeat until you can now longer bend the knee any further. I did this method for a minimum of 20 minutes every two hours. i
32. This method uses gravity and breaks down the fibrosed tissue quickly and you can add this to your heel slides in the floor.
33. If you are struggling to straighten the knee one of the tricks of the trade is to do very low side step ups. This can be done on a large book or even a thick carpet in the early stage. Stand sideways and step up onto the book and force your knee into a straightened position whilst standing and hold for 3 seconds. Repeat this 3x 5 reps 3 times per day. You can gradually increase the depth of the step week by week eventually using the step of your stairs. You will find this will help with walking up and down stairs in the first 6 weeks. You are firing the vastus medialis muscles, gluts and hamstrings as a unit.
34.This is a functional exercise as opposed to some of the exercises we get when we are discharged from hospital. A functional exercise is one we would use in our every daily life like walking up or down stairs or squatting to get in and out of a chair.
35. A second way of getting the knee fully straight is to lie on your front on your bed with the knee hanging over the edge. The weight of the leg plus gravity will allow it to drop into full extension over time. You can add a light weight to this by using a pair of oven gloves with a tin of fruit/beans in each pocket if you can tolerate it. I try to get my patients to build the time in this position to 15 minutes. Start with 2 minutes and build up daily a few extra minutes per day.
36. A slow progressive long stretch is more effective to alter tissue length. This is what we are after here. We are trying to stretch normal tissue back to its original length and prevent fibrose tissue from developing. Stretching for 30 seconds will not alter any tissue length permanently.

37. It’s imperative that you don’t get a joint infection. So in the first 1-4 weeks Keep that waterproof dressing on at all costs. Do not get it wet. Showers are ok but put a bin liner around it and keep your leg away from the main flow of water. Never soak that wound in a bath in the first 4-5 weeks. Your bath water, even if you put disinfectant in is a cess pit of bacteria. Remember if you get an infection it’s a surgeons/physio and eventually your worst nightmare. In a lot of cases you will have further surgery. That metal work will have to come out and the joint washed out and fitted with a temporary prosthesis with an antibiotic stem. You will be given main line antibiotics in hospital and feel very poorly for between 4-6 weeks. This is followed by a further joint replacement when the infection has cleared and this can be up to 6 months later. SO KEEP THAT WOUND COVERED. EVEN AFTER THE CLIPS COME OUT AT 14 DAYS.WHEN THE CLIPS ARE REMOVED THERE ARE SMALL HOLES FOR 48 HOURS WHERE THE CLIPS HAVE BEEN INSITU.

38. Bend and straighten that knee like crazy ! You have a 6 week window to get 120 degrees or more. The knee develops a very strong fibrous tissue from 48 hours following the surgery. It is a thick tissue that completely gums up the joint. If you don’t you will end up with a failed replacement and face further surgery in the form of a manipulation under anaesthetic. These are not pleasant as I have witnessed many in hospital care.It involves the patient being put to sleep and and the surgeon forcefully bending the knee quickly to tear the fibrous tissue which we call adhesions or scar tissue.
39. From discharge in hospital make sure you sit with your leg elevated (the back of the sofa is perfect or using a duvet rolled on a sofa. make sure the ankle supported but there are no cushions under the knee.

40. The wound should be dry and healed by 4 weeks. Only at weeks 4-5 can you submerse it in a bath safely, but only if that wound is NOT weeping.
41. Again, The emphasis is on bending that knee and getting full controllable knee extension (straightening). Use sliding boards or a sock underneath the heel on lino to slide the heel backwards and forwards whilst sitting. Or bending in a seated chair or even whilst on the toilet.
41. I used a foam roller to put under the knee to perform inner range quad exercises. This involves sitting on the floor with the back to the sofa and the roll under the knee. Straighten your leg by tightening your quads. You’re really working on the vast us medialis the muscle that wastes most ( the tear drop muscle) on the inside of your knee cap. 10 x 10 reps split in sets of 3 overs the day.
Straight leg raises 10 x 10 .
42. Use of a static bike or a turbo from week 2 . Four times per week starting with 10 minutes and add 5 mins per week.
The emphasis is to get the knee bending. So start with the saddle high. Peddling backwards is slightly easier to the knee mechanics and once you have achieved 10 or so revolutions backwards you can start to pedal forwards
Pedal slowly and try not to shift your hips to one side or the other (once it has warmed up ) and you will gradually find that you can sit straighter this may take a week to achieve. Remember the more you’ve been bending that knee with the foot on the wall plus all the normal exercises the easier the cycling will be.
43. Do not stop or ease off on the bending and straightening exercises they are boring but fundamental to a good outcome.
44. At week 5 you can increase the watts slightly as you will want to increase the power through the quads and hamstrings as you become stronger.
45. Each session try and move the saddle down a notch this will help increase the bend in the knee. The lower the saddle the more bend you will achieve. By week 4 -5 I had my saddle down as far as I could get it. Now remember this is not about increasing the power too much at this stage as your knee will give you pain as you will have over stressed it.
46. Week 8-12 continue strengthening the joint you can continue cycling and strengthening leg muscles with the use of therabands for the gluteal quads/ hamstring abductor adductor muscles. Also work on the upper body to keep it conditioned with core or Pilates exercises. Remember no twisting on that knee all must be done with a linear action - ie backwards and forwards.
47.Week 10- 12 to begin short rides outside but only if you feel ready. Each person is different it isn’t a race. Remember we don’t want to loosen that prosthesis.
48.The reason you dont want to cycle outside particularly in cleats within the first 0-6 is that there is a risk of accident and falling. Your balance isn’t as good as it was. If you fall and fracture the femur of tibia as the bone is still relatively weak in the first 0 - 12 weeks you will be on serious trouble as the metal work may have to come out and there’s a risk of infection into the bone and loosening of the implant. So any of you out there cycling outside before this is taking one hell of a risk. That’s why we advise the turbo or an indoor bike.
49. Remember you have more control on a turbo and there is less risk with the similar benefits plus there less chance some idiot will run us over.
50.SO WHY DO WE REQUIRE A REPLACEMENT KNEE ?
It is important to understand that ‘they are not ‘NEW knees’. They are artificial prosthesis made of inert metal and plastic. They are nowhere near as good as your previous natural joint. Your natural knee has worn out and you are in pain with severe limitation of your daily functions. This requiresyou to have replacement artificial joint. Your natural joint reproduces new cells and is lubricated by synovial fluid and is in a constant flux of degeneration and repair. Our joints in some cases go through a process of ‘ wear and tear’ otherwise known as osteoarthritis. Arthritis is an umbrella disease/pathology for many types of joint degeneration,it can include osteoarthritis, rheumatoid arthritis (which differs as its an autoimmune disease ie the body starts to recognise its own tissue as foreign and attacks it ) and is known as a blood born disease. it will give you a differential between the two osteoarthritis v Rheumatoid arthritis (RA). RA arthritis can include other arthritic groups such as Psoriatic arthritis, juvenile arthritis (children). Anything with the term ‘arthro’in it means joint. Anything with itis on the end means inflammation. Our bodies are constantly fighting stresses upon our whole system including trauma, stress which includes eating the wrong type of foods. So we insult our body and stress it.This can lead to varying levels of inflammation. We can put them into two main groups - acute and chronic. This is what we look for when we send patients for a blood test to look at the ‘inflammatory markers’.
51.The blood tests are a great way of ruling out many serious pathologies for example Cancers. The blood tests may also pick up high levels of inflammation depending which blood cells show higher or lower numbers. Remember the white cells are our soldiers and wage war on the bugs and other invaders in our system. Which is what you may experience with an acutely painful knee were it maybe hot and swollen.
52. You may be given non steroidal medication ( which are not pain killers their job is to reduce inflammation) .
53. Painkillers are known as analgesics and work totally differently from non steroidal medication, abbreviated to NSAIDS. Analgesics may include paracetamol, Co-codamol painkillers. They block the pain receptors on the cell membrane. They also are the devils that cause us constipation after our knee replacement or any other surgery as they slow the motility of the gut and food as it passes along the bowel. Hence why we need our laxatives. NOTE -make sure you take those laxatives you will feel greatly relieved and it literally is a load off your mind !!
54. The usual arthritis is osteoarthritis that causes havoc in our joints. This is usually slowly developing and there may be many causes, including poor biomechanics positions of the feet, acute trauma to joints and gradual wear to the joint. We may first notice the stiffness and soreness as in our early 50s ( don’t forget male and females are also undergoing huge hormonal changes from our 40s onwards which impacts our recovery. That’s why as we move into our 60s etc we can longer run cycle or swim to the levels in our 20s.
55.Males particularly produce less testosterone resulting in muscle wastage and our body fat levels can change radically. This is one of the reasons why exercise is important as it can stimulate these hormones and also our ‘feel good hormones’ like serotonin, oxytocin and dopamine. That’s why we can have a high after a great cycle.

56.Over the years the joint gradually degenerates and the cartilage thins on the bone ends
57..There are two types of cartilage in the knee :
A. Articular cartilage - this is the important stuff for us as we age. Imagine the bone ends being covered in a beautiful layer of fresh snow approx 2-2.5 mm thick. As the joint wears the appearance are those of big holes in certain areas of the snow where we can see the earth underneath. This is what we mean by osteoarthritis.
Eventually the holes become so big it that there is barely any covering at all.
58.The joint is now red and angry and inflamed. The damage is so extensive that the body cannot replace the damaged cartilaginous cells fast enough. This is why in the early stages physios always try to ask the patients to reduce the load on the joint and change training to lighter loads like swimming/ cycling and biking.
59.A lot of wear tends to take place on the inner aspect of the joint which is why you will see the joint space reduced markedly on the inner aspect in some cases. Of course the outside can wear also. This is how the surgeon decides if it’s going to be a partial or a full knee replacement.
The meniscus - is the second type of cartilage and it looks like the brake pads on your car or like a small stack of Pringle crisps stacked upon one another in 4-5 layers. The job of the meniscus is to keep the knee locked. This is the cartilage that he younger sporting groups injure as they twist and turn and split the meniscus. It’s a common reason for an arthroscopy. ( a small telescope with a cutter and camera on the end to trim and reset small segments of tissue within the joint)
So remember our problem is wear to the ARTICULAR cartilage.

WHEN DO YOU REQUIRE A KNEE REPLACEMENT ?
Once the joint has begun to degenerate rapidly, stiffness and pain start to ensure. Walking distances become a problem punctuated by periods of sitting to recover. As time moves in the walking distances become shorter and the rest periods become longer. Walking up and particularly downstairs becomes problematic. Walking up or down slopes becomes tiresome and a real effort. Household cleaning and getting and out of a bath can be an issue.
You will know when you need a joint replacement as your quality of life has rapidly deteriorated. Do not be swayed by sales of creams, lotions and potions or braces that claim that they can resolve your chronic wear they can’t. They may offer some temporary relief. Anti inflammatory steroid injections can help and although the popular myth is that you can only have 3 is not scientifically evidenced. I have used and injected many of my patients with both steroid and hyloronic acid but both only act to reduce symptoms and are rarely a long term solution once significant cartilage degeneration occurs. There is also a process of nerve denervation which is basically burning of the nerve to the knee. This usually requires repeated treatments and is not a long term solution. It does not repair the joint surface.
Currently the only solution on offer once the joint becomes seriously and pathologically changed is either put up with it plus NSAIDS and analgesia which is temporary or a joint replacement. In the early stages of degeneration you could undergo cartilage cell implantation but this is usually for younger patients with minor wear patterns and is to prevent further knee degeneration warranting knee replacement.
The patient who undergoes and follows the correct rehab program invariably finds they achieve a satisfactory outcome and their quality of life is hugely enhanced.
Robotic v Conventional Replacement.
Recently there has been a lot of coverage in the press regarding the better option. The suggestion of a robot during your surgery does not mean that the robot performs your surgery. A robotic arm is used by the surgeon to cut away the diseased tissue. Now which is better ? The figures from the robotic use v a highly experienced surgeon is negligible. The robotic arm technique is still in its infancy and tends to be used mostly by lesser experienced surgeons. Personally I chose the more experienced surgeon with an high outcome success. To date I have achieved a highly successful outcome which at week 8, I am highly delighted with. So my message is choose your surgeon wisely. There are figure available on the NHS websites which give patient satisfaction and surgical outcomes. Take a notepad and pen to the consultation and grill him/her. You are not being rude. Remember it is your knee and you have to live with the consequences not he or she. Do not let him or her out of that room until they have answered all your questions.

[Lookrider]

That's the one
Thanks very much for finding it
And thanks to bamphysio

[nurgles]

Hi
As background, I have been a cyclist all my life.Joined the CTC as a 15 year old and toured Europe in the sixties.I'm now 75 and have had two full knee replacements,LHS 6 years ago RHS last year.

The first one was not so bad but the one last year has been a major issue for me.I have reduced the length of both cranks and can ride again but not too far.My main problems are back ache as a result of walking differently and wrist pain due to arthritis .

I have not read all of bamphysio's post

Good luck@!

[Lookrider]

Sounds familiar
I bust me knee as a 19yr old 58 now compensating has also developed to a slightly bent back as well over the years

[kevberlin]

Aged 57, in 2012, I had a full knee replacement. The post operation period was unpleasant and the focus was on mobilisation and reducing swelling. The more I pushed the joint, then the more it would swell. Gradually, however, the swelling reduced as I pushed onwards. My days became filled with mobilisation exercises followed by ice. I recall sitting on the kitchen table swinging my leg for hours and doing similar sitting with my leg hanging over the arm of the sofa.
Walking aided and then unaided increased over the early months.
I gradually learnt to trust my prosthesis.
Within a year I was cycling and two years later did Ventoux.
I continue to cycle and walk regularly, but have always treated the prosthesis with due respect.
In summary, it’s an unpleasant operation, but the results can be first class if you focus on rehab and treat the joint appropriately.
Best wishes.

[Lookrider]

Thanks for that
I'm due mid August for operation
Would you say your life is better and your able to achieve more now both on the bike and walking
Even though your re hab was around a year

[kevberlin]

My injured knee was slowly becoming increasingly bent, so that it bowed outwards. It was painful, like a constant toothache though I did walk and cycle. The deciding factor was that the bent knee joint was displacing my hip causing intense further pain.
After the operation, I could see the surgeon’s pen marks on my foot and leg used to ensure the new joint was aligned correctly. The hip pain was gone and has never returned. Sure, the operation was unpleasant, and rehab was intensive but I have no doubt that my life is much better for having had the operation.
If you put the work in to rehab and manage your new joint sensibly, there is no reason to believe it will prove to nothing other than a success. As a final thought, I also understand that the surgery has improved since mine was done.
I hope all goes well for you.
Kev

[Lazycarton]

I had a total L knee replacement last August. I was 69 and first time in hospital as an in-patient. I have cycled since I was about 32. My L knee became very painful and sore a couple of years before I was told I had done too much road running and that I should take up cycling. Which I did.

I bought a turbo trainer years ago but not really used it as it was so boring. So I brought it up to the house and used it to mobilise the knee and to increase the bend safely and gradually over the initial post surgery weeks by increasing the saddle height bit by bit and I found this invaluable. Yes, you must go through the pain barrier sensibly immediately after the op or as others have said you might well have not bothered. Do all the reccomended exercises religiously every day.

I was out on the road on a bike after about 4 weeks and constantly increasing my walk lengths and off the crutches (I could only use one crutch anyway as it was much easier) in about 3 weeks.

My knee is still a bit stiff and in March I went back and had an X-Ray and all was well with it and I was told it should be ok by 12 months post op. Kneeling is not that easy but only because it is painful to put pressure on the scar over the kneecap, not beacuse of restriction. If your knee is buggered then a new knee will keep you on the move and doing what you were in the past.

[Lookrider]

Thanks for all this advice as I'm getting anxious not as much for the op itself but the recovery period and the performance of the new knee
My background was a bad break at 19 ..I'm now 58
The break needed pinned together etc as the years wore on the pins became loose and tore away at the cartlidge and other factors arthritis cysts miniscus etc
The surgeon said no doubt I need full replacement

However I can still ride a 100 plus day out on bike
My knee is not in any day to day pain no tramadol etc but it does kinda breakdown and then I can be limping about for several months whilst on physio treatment ..twice I was confined to electric mobility scooter just to get about
When it does breakdown it is very painfully and extremely stiff both to bend or straighten
The surgeon is aware of all these factors and has said he cannot repair it either as it's " shot "
I'm concerned that the shelf life approx 15 years means what will I do mid 70s ( I may not even be here ??) so part of me thinks to just push on and on until it breaks down completely
But the downside is I have been on hiking holidays days out etc and it's been spoilt as me knee has given in and I'm confined to indoors and then physio to get some normality back

[Lazycarton]

Getting a new knee was a no brainer for me. Where would I be now if I hadn't? Not walking and not cycling and having a micturate poor retirement.

[Lookrider]

Can I be rude and ask your symptoms
I guess each case scenario will differ

I do see people walk bandy leg because of the need for new replacement
Same with pain killers and injections etc
I'm none of them in reality

Guess I'm wanting to hear as many success stories as possible
One guy upthread even did a mountainous TdeF climb ....hats off to him

[Lazycarton]

My L knee got to a point where I couldn't walk more than 1/4mile without it causing pain all the way down my shin and the in knee cap and it felt like it was fused and I couldn't bend it. I had to hobble back home. 2 years before this I went to my GP and he sent me for an X-Ray which I was told showed "normal wear and tear". By the time I saw the specialist (referred privately on NHS) he said thst it was completely shot and there was no way that the knee was in any condition to just turn me away and the result was how it deteriorated so quickly.

[Lookrider]

I'm not like that ..I only get that sort of pain and stiffness when I have the sporadic " breakdowns "
Just now it's fine
The surgeon I'm under says on a scale of 1 to 10
It's easily damaged to a 10
Of course he be trying to appease me and settle my judgement

[deeferdonk]

My father has two dodgy knees, has had one replaced and is on waiting list for the other.
He found during recovery that his other leg got worse as he was favouring that one whilst walking/going up stairs etc He found using 2 walking sticks beneficial when taking his recovery exercise walks to put a balanced load on his body and to stop from healing into a permanent limp. He was recommended to do this by a passing physio he got chatting to when he was out walking up the road with a single walking stick.